Painful digital ulcers

[Greetwell]

Hi

I have Raynaud's as a consequence of scleroderma. Still having tests to pin down whether any of my internal organs are affected. For the last 15 months I have had an ulcer on one of my fingers which is refusing to heal. Today my consultant prescribed sildenafil to hopefully accelerate the healing process. Has anyone else been prescribed the same or similar drug and has it helped. Also whilst waiting for the ulcer to heal I would like to find some way of protecting my fingertip which is very sensitive to touch or minor knocks. Again has anyone found anything that works? I have tried various things, like a finger stall, but as I said anything touching the end of my finger is painful. Thick gloves do work but not much good if you are trying to do up a button! Finally I'd appreciate some advice on keeping your fingers warm. I have some battery operated hand warmers which are quite good. Others may have found equally effective methods.

Thanks for your help

David

[tall-tim]

Hello.

I have about 8 years' experience of using Sildenafil for cold hands and to improve healing. It can be relied on whenever painful cold grips my fingers. It can be taken prophylactically whenever I know I am going out into challenging conditions. I often do work out of doors.

I use wrist warmers in most months of the year. The best I find is cutting lengths of stocking bandage to size; any material thicker than that can get in the way of my cuffs. I use the 'oatmeal'-coloured fingerless gloves sold through the Raynauds & Scleroderma Assocation. They get dirty quickly and are quite expensive for the length of time they last, but do help keep wrists and backs of hands warm and hence keep fingers warm.

Keeping core body temperature up and regular is good policy. I do this by wearing several thermal layers topped by a padded gilet/waistcoat most months of the year. A neck warmer (snood/scarf/turtle neck) helps retain body heat too, not to mention hats and thick socks and solid boots.

I heartily sympathise with the finger ulceration problem. My solution is to soak them in hot water with dettol to help wick the corruption up towards the surface, and to debride the ulcerous skin with a sharp blade to prevent the chalky liquid and any infection from ponding painfully under the surface. The dettol treatment makes them less painful too for an hour or two. The ulcer can then be dressed with Inadine iodated gauze covered with plasters (eg Tesco strips cut to size - nb Morrisons ones are no good for this) to keep bacteria at bay. You can use small Mepore plasters too, cut to shape.

Another issue for me is very occasional white crystals working their way up through the ulcers. They make gripping things a pain. I had one emerge this week from the pad of my thumb! In my experience, the warm-water-&-dettol soaking and debriding treatments are the only way to beat them. Once they are at the surface you can easily probe and then winkle them out. The ulcer then heals quickly (two or three days).

Hope this info is helpful. Bon courage!

Tim

[Greetwell in reply to tall-tim]

Hi Tim

Thank you for your really helpful comments. I hadn't thought of self-debriding but it sounds like a good idea. I know something is going on under the surface but I hadn't thought of a way of bringing it to the surface by soaking. I will try it. I've just started to use pure lanolin to soften the tip of my fingers. Too early to say whether it will make a difference.

Thanks again.

David

[Rubytunes]

hi it maybe worth looking on the sruk site to see if the webinar from about 18 months ago on digital ulcer care is still available. The team in Leeds under Prof Delgado agreed to see me and were incredibly helpful as my GP had decided that my issues were contact dermatitis for some reason.

Soaking my hands in warm water with a bit of salt to soften and get rid of the dead, crusted areas was a game changer. I use medicinal honey then and a dry dressing. Urea cream helps keep rest of skin moisturised - and making sure I’m well hydrated.

Hope this makes some sense

[Greetwell in reply to Rubytunes]

That makes a great deal of sense. Thank you. I've started immersing my finger tips in hot water and using pure lanolin to soften and moisturise afterwards. Your remedy supports this kind of approach. I'm probably not being as consistent with the treatment as i need to be but what i've done so far has alleviated much of the discomfort that i had before. i'll look for the webinar you mentioned.